Provider Enrollment & Credentialing Specialist

Total Life, Inc.

12d•$50,000 - $70,000•Remote

About The Position

The Provider Enrollment & Credentialing Specialist is a vital role that ensures our clinicians are fully vetted, licensed, and panelled with insurance providers to deliver care to our senior population. You will serve as the primary link between the recruitment of new providers and their ability to begin seeing patients. This role requires a high degree of organization, a deep understanding of Medicare/CMS guidelines, and the ability to navigate complex state-specific licensing requirements.

Requirements

2–6 years of experience in provider credentialing or enrollment, preferably within a behavioral health or telehealth organization.
Demonstrated experience with the PECOS, NPPES (NPI), and CAQH portals.
Deep understanding of the credentialing requirements for LCSWs, Psychologists, and other mental health professionals.
Familiarity with the licensing boards and enrollment timelines for all US states
Exceptional accuracy in data entry and a "compliance-first" mindset.
Ability to communicate clearly and professionally with clinicians, insurance representatives, and internal stakeholders.

Nice To Haves

Certified Provider Enrollment Specialist (CPES) or Certified Professional Credentialing Specialist (CPCS).
Experience with credentialing software and EHR platforms.
Executive Partnership: Direct partnership with executive leadership to influence strategy, processes, and financial performance at an enterprise level.
Purpose-Driven Work: The ability to influence the financial health of a movement dedicated to the mental wellness of the 65+ population.

Responsibilities

Manage the collection, verification, and maintenance of all provider credentials, including professional licenses, board certifications, DEA registrations, and malpractice insurance.
Oversee the submission and tracking of enrollment applications for Medicare (PECOS), Medicaid, and commercial insurance panels (e.g., Humana).
Maintain and update provider profiles in the CAQH ProView database, ensuring timely re-attestations every 120 days.
Conduct thorough background checks and verify education, training, and work history to ensure compliance with NCQA and CMS standards.
Update and maintain accurate provider data within internal systems (TLOS and Healthy) to ensure the Active Care team has real-time visibility into provider capacity and expertise.
Proactively monitor and notify clinicians of upcoming license or certification expirations to prevent gaps in service or billing.
Collaborate with the Revenue Cycle Management (RCM) team to resolve claim denials related to provider credentialing or enrollment issues.